Bangladesh, from an epidemiological perspective, is evolving rapidly. While still a low prevalence country for overall HIV rates, a small pocket of IDU under second generation surveillance has shown an HIV prevalence increase from 1.4 per cent to 4 per cent to 8.9 per cent (in one locality) in the past three years. Simultaneously recent Behavioral Surveillance Survey (BSS) data indicate an increase in risk behaviors such as sharing of injecting equipment and a decline in consistent condom use in sexual encounters between IDUs and female sex workers. BSS data also indicate that the IDU population is well integrated into the surrounding urban community, socially and sexually, thus raising grave concern about the spread of HIV infection

Results from this national HIV surveillance system show that the prevalence of the virus that causes AIDS is still less than 1 per cent among other vulnerable groups surveyed, namely men, women and hijras (transgenders) who sell sex, their male clients (truck drivers and their helpers, launch workers and STI patients), men who have sex with men, and babus in brothels. But unfortunately the low HIV infections present in these groups is not due to a decrease in risk behavior. The survey recorded higher percentages of men buying sex than measured elsewhere in Asia.

The alarming reality is that the majority of men still do not use condoms in commercial sex encounters, and female sex workers report the lowest condom use in the region. About two-third of the rickshaw pullers and truck drivers surveyed reported that they never touched a condom in their lives and they had no idea of the risk of having an HIV exposure.

The report stresses that needle sharing continues to be routine among injecting drug users and the number of new injectors are increasing.

The survey pointed out that contrary to the common belief, injecting drug users are not isolated. They are linked with the rest of society -- they have regular sex partners, they buy sex from women, as well as other men, they sell blood, and they also move between cities and inject. "This close interaction and sharing network among vulnerable groups can potentially spread the epidemic widely to the general population although it is now in mild or concentrated form" -- said Major General Dr Matiur Rahman who was presenting the content of the report at the launch.

The report also presented some positive news, namely that interventions are able to contribute to behavioral change. This is reflected in the declining syphilis rates among female sex workers in some cities and brothels and in declining needle and syringe sharing rates among injection drug users. But, data shows that coverage is still inadequate regionally, and the needs of many people at risk not being addressed.

The relatively low level of HIV in Bangladesh today does not guarantee low prevalence tomorrow. Experience teaches us that early epidemics do not show their magnitude at first and place few demands on the health sector. All the risk factors which give birth to explosive HIV epidemics are present in Bangladesh today. In the absence of good quality and high coverage intervention programmes, HIV prevalence may jump to very high levels within months. Once HIV prevalence crosses the 10 per cent level, epidemics become very difficult to control. Policy makers and programmers within the Government of Bangladesh, bi-lateral agencies, national and international NGOs have a key role to play in recognizing the urgency of the situation and taking immediate action.

Robert Kelly is Country Director, Family Health International (FHI).